304370945-6-20-2022-06-CC-PMAA-CFPT23-20220624142002

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304370945
Report Date: 06/20/2022
Date Signed: 06/20/2022 01:30:41 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/05/2022 and conducted by Evaluator Mila Quinto

COMPLAINT CONTROL NUMBER: 06-CC-20220405101743

FACILITY NAME:	CHERRY BLOSSOM ACADEMY		FACILITY NUMBER:	304370945
ADMINISTRATOR:	NGUYEN, MELISSA U.		FACILITY TYPE:	850
ADDRESS:	9881 TRASK AVENUE		TELEPHONE:	(310) 741-9554
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92844
CAPACITY:	24	CENSUS: 19	DATE:	06/20/2022
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Melissa Nguyen, Director		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff member smacked 2 children on the mouth

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Mila Quinto conducted an investigation visit to the facility to deliver the finding. LPA met with Director, Melissa Nguyen. The Covid-19 Emergency Response questionnaire was reviewed and answered by the director. Census was taken. There was a total of 19 preschool children with 3 staff members.
A review of facility Personnel Report Summary on this date indicates that all facility staff or other individuals who require caregiver background checks do not have criminal record and child abuse index clearances or exemptions. Staff, Kelly Le was caring for 9 preschool children.
Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Mila Quinto	TELEPHONE: (714) 293-6471
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 06-CC-20220405101743

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CHERRY BLOSSOM ACADEMY	FACILITY NUMBER: 304370945
	VISIT DATE: 06/20/2022

NARRATIVE

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On 04/05/2022 a complaint was received alleging that staff #3 smacked 2 children on the mouth. LPA interviewed complainant on 04/05/2022 and was not able to obtain specific details or names of alleged victims. LPA was able to obtain police report and there was no other information provided to support the allegation.

On 4/8/22, LPA interviewed 3 staff members including the Director. According to the Director, on 3/17/22, while she was out of the facility, she received a phone call from staff regarding a police officer was at the facility. The director stated she conducted her own interviews with all 3 staff members and A1. The Director received conflicting information. There were no disclosures from the 2 staff interviewed. LPA attempted to interview and qualify 4 children, however all 4 had limited verbal skills and LPA were not able to qualify the 4 children. On 5/3/22, LPA called 10 parents and interviewed 4 of the 10 parents. There were no disclosures made from the 4 parents interviewed. LPA did not receive a return call from the other 6 parents.

On 4/15/22, LPA conducted a phone interview with A1. According to A1, on 3/16/22, while the children were running around in the classroom, 2 preschool children were yelling. A1 witnessed S3 smack the 2 preschool children on their mouth. A1 stated that one child cried. A1 was unable to provide names of the children.

On 5/10/22, LPA conducted a phone interview with S3. S3 denied smacking the preschool children on their mouth S3 stated that the children were only asked to stop running.

Based on interviews conducted, the complaint alleging staff member smacked 2 children on the mouth is found to be unsubstantiated. Although the allegation may have happened or is valid, there is not enough preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Mila Quinto	TELEPHONE: (714) 293-6471
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 06-CC-20220405101743

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CHERRY BLOSSOM ACADEMY	FACILITY NUMBER: 304370945
	VISIT DATE: 06/20/2022

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Page 3 Exit interview was conducted. Notice of Site Visit was posted during the visit. Director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Mila Quinto	TELEPHONE: (714) 293-6471
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3